The 2018 eHealth year in review: part three

Written by Kate McDonald on 20 December 2018.

The second half of the 2018 year in eHealth got off to an absolute shocker, with bad press following social media uproar over the opt-out period for the My Health Record. ADHA's phone lines were busy in the first few days as expected, but things just continued to get worse as misinformation about the My Health Record legislation and who would have access to the system began to circulate.

Back in May, ADHA CEO Tim Kelsey had told the National Press Club that a comprehensive communications campaign was being prepared to inform the public about the system and how they could opt out if they wanted to, but few saw any sign of this as the three-month opt-out period began. It was left to the mass media to explain the initiative and apart from some notable exceptions at the ABC, that did not go well.

Consumer information packs only started rolling out to GPs the week before opt out began and the RACGP gave the initiative a lukewarm blessing at best in its position statement. The college is still opposed to targets for shared health summary uploads and the use of the ePIP to bludgeon them into using the system. The Australasian College of Health Informatics (ACHI) also released a tepid greeting, calling for a restructure of the system to make it useful.

The drama continued to burble along when newly elected AMA president Tony Bartone gave his own speech at the NPC. What was an excellent presentation on practical ways to fix multiple problems in the health sector, starting with the primacy of primary care, was lost amid the ongoing saga about the My Health Record. Dr Bartone was forced to promise that the AMA would do whatever it takes to resolve any ambiguity over the privacy aspects of the system.

While it has always been policy that law enforcement officials have to get a court order to access the system, the fact this is not explicitly stated in the legislation led to increasingly hysterical claims in the media about who could actually have access to the system. Health Minister Greg Hunt finally folded and agreed to tighten the privacy provisions in late July. Labor, sensing a weakened opposition, pushed for a new Senate inquiry into the My Health Record, and got one.

While My Health Record dominated the headlines, the rest of the eHealth world moved on. GP superclinics in Victoria launched a diabetes service supported by Precedence Health Care's MediTracker app to help medical and allied health providers keep patients on track with their health goals. Funding has been provided by Eastern Melbourne PHN, which is also trialling the use of the My Emergency Dr app for after-hours care.

A highlight of every year in eHealth in Australia is the annual Health Informatics Conference (HIC), which was held this year in Sydney. Notable events at this year's HIC included the announcement by eHealth NSW CEO/CIO Zoran Bolevich that the states and territories had agreed to harmonise the content of the jurisdictional baby books given to parents to record their baby's growth milestones. This is part of the National Children's Digital Health Collaborative, which is aiming to develop a longitudinal health record for Australian children and will in future be linked to the My Health Record. Also at HIC, HISA, HIMAA and ACHI got together to voice their support for the My Health Record after the torrid reception of the opt-out period, and ADHA chairman Jim Birch brightened the mood with a link between the MyHR shenanigans and Alec Baldwin doing Donald Trump channelling Russell Crowe's famous are you not entertained? scene in Gladiator.

Still at HIC, we also heard from Royal Children's Hospital's Mike South and University of California San Diego Health CIO Chris Longhurst on the topic of EMR-linked clinician burnout. While not yet the problem here as it is in the US, the fact the story was one of our most read for the year shows there is interest in the topic. Professor South drew attention to the differences in clinical and administrative use of EMRs, and hoped that by bringing attention to the problem, Australia and New Zealand can potentially avoid it.

We also got an update on the Northern Territory's huge core clinical system renewal project (CCSRP) from its technical and clinical leads. The $259 million project to roll out InterSystems' TrakCare across primary and acute care is scheduled to be piloted at Katherine Hospital and its clinics next October. The other regions will then follow over the next two years. The NT also released a tender for a new enterprise data warehouse, but that tender has since been cancelled.

September was dominated by the Senate inquiry into the My Health Record, which heard quite a lot of nonsense but nothing really new to anyone who has been following its tortured journey. Considering the awful press that has surrounded the system and what opt out means, it came as something of a surprise that only about three per cent of eligible people had opted out between the start date in July and the Senate hearing in September. The rate of people opting out had slowed, but was expected to pick up again as the November 15 deadline approached. Considering the chaotic scenes that surrounded that date, it is a fair assumption that the opt-out rate will eventually be higher. Of more concern in September was that 40 per cent of people still weren't aware they could opt out.

At the end of the third quarter, a storm in the primary care software market was set off when we revealed that the RACGP was partnering with Canadian software vendor Myca Health to build an Australian version of its Hello Health software. Local vendors were furious and plenty of RACGP members were none too happy as well, fearing the reputation of the college would be sullied by it appearing to sell its endorsement. This drama would continue into the next few months as the year drew to a close.

Primary care

Primary Health Tasmania issued a request for proposal in August for a statewide eReferral system that will initially facilitate electronic referrals between GPs and specialists and in future integrate with Tasmanian hospital systems and deliver eReferral letters to the My Health Record.

The South Western Sydney PHN launched its big Integrated Realtime Active Data (iRAD) interoperability project, which is using Allscripts' dbMotion solution to deliver relevant patient data in a concise view within clinical workflows to ED clinicians and GPs. It went live in the first week of September in five pilot practices, with the emergency departments at Campbelltown, Bowral and Camden hospitals also participating.

The progress of the Health Care Homes trial in Australia has been of concern for some time, with slow patient recruitment and a number of technological hurdles to overcome. Marienne Hibbert from Precedence Healthcare, which built the PracticeProfiler risk stratification tool (RST) for the trial, said data quality was a major issue, as was the sheer number of old versions of software operating systems still being used in primary care. There also seem to be some issues with patients not wanting to take part in the trial if they had to have a My Health Record. The Department of Health quietly dropped this requirement in November.

Brisbane firm Longevum picked up a big contract with Western Sydney to roll out a diabetes self-management app as part of the Western Sydney Diabetes (WSD) initiative. The plan is to allow patients to access their GP care plan, along with the ability to schedule appointments, see their medication history and receive tailored self-management tools. This was a hotly contested tender with a few big names missing out.

Acute care

Children's Health Queensland Hospital and Health Service went to market to look for a patient online portal (POP) solution that may in future be rolled out to other HHSs. Patient portals are increasingly a feature for paediatric hospitals, with Royal Children's in Melbourne providing access to patients' test results through its portal, and Sydney Children's Hospital Network doing the same at Westmead and Randwick with its Memory strategy. Westmead is also allowing clinicians to read messages from their patients from within their EMR through an app developed by Oneview.

Peninsula Health also made a splash with the uplift of its Cerner EMR to become the first health service in Australia to upload a CDA 3A discharge summary to the My Health Record using Cerner's Dynamic Documentation (DynDoc) capability. Peninsula has done a lot of the work on its own – and paid for half of it – as opposed to certain other health services in Victoria that seem to be showered with largesse.

In August, Victoria went to market looking for a vendor neutral clinical information sharing (CIS) solution that can integrate with the different EMRs and PASs used by the state's 151 hospitals. We understand the Victoria wants to model the CIS on the NSW HealtheNet system, with procurement over multiple stages.

Some of the more interesting software, apps and new players in the market that caught our eye this quarter included:

IP Health worked with long-term customer Mater Health in Queensland to allow Mater clinicians to have access to Queensland's The Viewer portal through its Verdi integration platform. It also worked with the VCCC to let its clinicians access combined cardiac ultrasound images and reports generated from GE Healthcare’s ViewPoint 6 system. IP Health revealed this year that Telstra had divested itself of its 33 per cent interest, with the company now back as an independent concern.

Newcastle not-for-profit ProCare Mental Health Services won a tender to provide clinical advice to GPs on managing psychiatric patients in the primary care setting. The free service, delivered by telehealth and supported by secure messaging, is available to GPs in six PHNs and was immediately popular.

Philips made a bit of a splash in July when it announced it had entered the Australian EMR market, rolling out its Tasy system for St Andrews Private Hospital in Toowoomba. The web-based system seems to be aimed at small private hospitals not keen on hosting an EMR themselves and is being heavily promoted by Philips here and in New Zealand.

MEDITECH also made a splash with its Expanse platform, an integrated, web-based EMR designed for mobile, tablet-based navigation.

Patient reported outcomes are becoming increasingly important for healthcare providers, and Sydney start-up CancerAid is working on this with its app, thought to be the first consumer app for oncology patient-reported outcomes that is integrated into an EMR. Chris O'Brien Lifehouse is testing the app in association with MEDITECH, which is rolling out clinical modules there.

Telstra Health worked with St John of God Health Care to build a Doctor Connect app that allows VMOs and specialists to connect to hospital patient administration systems to get a list of patient admission and contact details, allergy and alerts, and pathology and radiology results. It also lets surgeons see a real-time feed of current theatre bookings, along with their patients' details, procedure and anaesthetist.

Tomorrow, we'll wrap up our look at the year in eHealth and reveal our top 20 most-read stories for 2018.